Successful treatment will help you live a normal life with less or no pain.
When you have an inflammatory condition like ankylosing spondylitis, it can sometimes be hard to tell if treatments are successful. Sure, the lack of pain can be a sure sign; however, inflammation can sometimes be more subtle, and it can cause damage to the body even if you don’t initially feel it. With ankylosing spondylitis, that damage could include the fusion of the spine—which successful treatment aims to prevent.
Treating Ankylosing Spondylitis
A major component of treatment is lifestyle changes for ankylosing spondylitis, such as practicing good posture and staying physically active. “Patients that have ankylosing spondylitis actually have more pain with inactivity, so it’s very important for them to keep moving and have an exercise regimen,” says Eliana Cardozo, DO, assistant professor of Rehabilitation Medicine at Icahn School of Medicine at Mount Sinai.
Then, there are medications, and the primary medications for this inflammatory arthritis are nonsteroidal anti-inflammatory drugs (NSAIDs). Most people know these as over-the-counter pain relievers like ibuprofen, but for ankylosing spondylitis, these are given as prescription-strength medications.
“If those are not enough, there are other medicines available,” says Dr. Cardozo. These include biologics like tumor necrosis factor (TNF) inhibitors, which block the action of an inflammatory cytokine in the immune system; steroid injections, which temporarily relieve pain in the joints; and some oral medications like methotrexate. Learn more about treatment for ankylosing spondylitis here.
Is Your Treatment Working?
“For ankylosing spondylitis, a really important part of knowing if your treatment is working is your pain levels and also how functional you are,” says Dr. Cardozo. “Your physician or healthcare provider may ask you to fill out a survey where you can mark down what kind of things you can do with pain and what kind of things you’re doing without pain.”
Ultimately, the goal is for you to be able to live as normal of a life as possible, without the pain of ankylosing spondylitis. If you are trying one treatment method and still experiencing back pain that is keeping you from your everyday activities, you and your doctor may need to consider other treatment options.
“Another way [to see if treatment is working is] your physician might take some laboratory tests of inflammatory marks in your blood and might follow that to guide their treatment,” says Dr. Cardozo.
Basically, when the immune system is active, it releases inflammatory substances (such as cytokines). When your immune system is working properly, these inflammatory substances help with the process of attacking the foreign object and making your body uninhabitable for the pathogen. This is what causes the pain, swelling, and redness in acute inflammation (such as when you have an infected cut).
But when you have an autoimmune disease like ankylosing spondylitis, your immune system stays active and continues to release these inflammatory substances. Blood tests can check the levels of inflammatory markers circulating in your blood: High levels would suggest that your body continues to be in a state of inflammation, despite treatment. This would be another reason to consider changing to a different treatment method.
Getting the treatment “right” is crucial to improve your quality of life and to prevent spinal fusion. “If the patient is feeling some issues with their treatment, they should definitely either talk to their physicians or maybe seek an alternative opinion from someone,” says Dr. Cardozo.
Dr. Cardozo is an assistant professor of Rehabilitation Medicine at Icahn School of Medicine at Mount Sinai.
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So in ankylosing spondylitis,
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there's a few different treatment goals.
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The first is to make the patient as functional as possible.
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You do that by decreasing their pain as much as you can,
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and also modifying some of their activity.
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Patients that have ankylosing spondylitis actually have
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more pain with inactivity, so it's very important for them
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to keep moving and have a exercise regimen.
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Next are medications.
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The first-line medicines for this condition are
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nonsteroidal anti-inflammatory medicines.
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Nonsteroidal anti-inflammatory drugs are a class
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of medications that can help with inflammation
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in certain conditions.
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You can typically buy them over-the-counter,
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but for this condition, usually they're given
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as prescription-strength medications.
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And if those are not enough, there are other medicines available.
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One is tumor necrosis factor inhibitor, which is a medication
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that stops a cytokine called tumor necrosis factor,
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which is an inflammatory cytokine.
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There are also some injection options,
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so there can be steroid injections done to some of the areas
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of inflammation such as the sacroiliac joints.
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And if other joints are affected, which is less common
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in this condition, there's also injection options
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for those joints as well.
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For ankylosing spondylitis, a really important part
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of knowing if your treatment is working is your pain levels
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and also how functional you are, so your physician
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or healthcare provider may ask you to fill out a survey
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where you can mark down what kind of things you can do
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with pain and what kind of things you're doing without pain.
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That's one way to do it.
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Another way is also your physician might take
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some laboratory tests of inflammatory markers in your blood,
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and might follow that to guide their treatment.
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Ankylosing spondylitis is a lifelong disorder.
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It will have kind of waxing and waning courses,
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so it really depends on how their own disorder progress is going.
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We know that untreated ankylosing spondylitis
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actually has more rapid progression of disease
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and inflammation in the joints, which can then progress
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to erosion of the joints and even fusion,
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which is why it's called ankylosing.
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That's another word for fusion.
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So if the patient is feeling some issues with their treatment,
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they should definitely either talk to their physicians
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or maybe seek an alternate opinion from someone.
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Diagnosis of ankylosing spondylitis. Van Nuys, CA: Spondylitis Association of America. (Accessed on March 4, 2020 at https://www.spondylitis.org/Ankylosing-Spondylitis/Diagnosis/blood-work-ankylosing-spondylitis.)
Medications used to treat ankylosing spondylitis and related diseases. Van Nuys, CA: Spondylitis Association of America. (Accessed on March 4, 2020 at https://www.spondylitis.org/Medications.)
Treatment of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults. Waltham, MA: UpToDate, 2020. (Accessed on March 4, 2020 at https://www.uptodate.com/contents/treatment-of-axial-spondyloarthritis-ankylosing-spondylitis-and-nonradiographic-axial-spondyloarthritis-in-adults.)